Understanding the Health Care Mess

For more than 20 years, Americans have been pondering What To Do About Health Care. Everyone seems to agree on the major problems:

• Health care is expensive;
• health care is getting more expensive faster than nearly everything else;
• expensive health care is hard for poor people to pay for;
• and health insurance as it is currently set up isn’t working to provide health care.

If we turn these around, it seems we share some basic assumptions, axioms, for what a health care solution should look like:

• Everyone should be able to get health care;
• the cost of health care should go down, or at least stop growing so fast;
• people should be able to choose their own health care providers;
• and we’re unwilling to let someone bleed to death on the steps of the hospital because they don’t have some form of insurance.

Our current system for providing and paying for health care is neither solving the problems, nor providing the positive results we would like, so for many years we have debated, modified, and argued over changes to the health care system to be imposed from the federal government in order to make things better.

Somehow, things have gotten worse instead.

When I started this health care and insurance series, I really wasn’t aware that I was starting a series — I just wanted to explain things that were pretty obviously not clear to people who weren’t specialist wonks, and in particular to explain parts of the debate in which politicians were making promises that just weren’t arithmetically possible.

Of course, part of the problem is that the politicians are very well aware that the average voter simply doesn’t know enough, doesn’t have the tools and the data, with which to evaluate their various schemes. Professor Jonathan Gruber of MIT accidentally gave the game away on tape when he said:

Lack of transparency is a huge political advantage, and basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.

What Gruber was really saying is simple: people don’t understand what’s going on, and we don’t want them to understand, because if they did people wouldn’t go for it.

So — I realized in the middle of the night not long ago — the real purpose of this series is to explain the pieces so that people can make their own decisions, and, I hope, see through the smokescreens that politicians erect to keep the general population out of the way.

The truth is, health care policy, funding, and regulations have a lot of knobs — a lot of knobs — and changing any of them can change the whole system in unexpected ways. But I really think, if we approach this in a systematic way, anyone can understand the basics and make their own choices.